Provider Demographics
NPI:1164532024
Name:ALLERGY AND ASTHMA CONSULTANTS OF THE OZARK,LTD
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA CONSULTANTS OF THE OZARK,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:VANDEWALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-634-7000
Mailing Address - Street 1:1233 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2469
Mailing Address - Country:US
Mailing Address - Phone:573-634-7000
Mailing Address - Fax:
Practice Address - Street 1:1233 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2469
Practice Address - Country:US
Practice Address - Phone:573-634-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2F17207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty